EEOICPA Dose Reconstruction Interviews and Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Part B Sup Sta 0920-0530.docx	Supporting Statement B	Uploaded 2012-01-12	Available
Att F_HSRB.doc	Supplementary Document	Uploaded 2012-01-12	Available
Att B_HHS Privacy Impact Assessment.doc	Supplementary Document	Uploaded 2012-01-12	Available
Att A_PL 106-398.doc	Supplementary Document	Uploaded 2012-01-12	Available
Att E_60d FRN.pdf	Supplementary Document	Uploaded 2012-01-12	Available
Part A Sup Sta (0530).doc	Supporting Statement A	Uploaded 2012-01-12	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6981	EEOICPA Dose Reconstruction Introductory Letters & Telephone Interview	Other-WORD	Modified
188308	EEOICPA Dose Reconstruction Interviews Conclusion Form	Other-Word	Modified

ICR Details

OMB Control No: 0920-0530	ICR Reference No: 201201-0920-006
Status: Historical Active	Previous ICR Reference No: 201002-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: EEOICPA Dose Reconstruction Interviews and Form
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/13/2012
	Date Received in OIRA: 01/18/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2015	36 Months From Approved	03/31/2012
Responses	12,600	0	12,600
Time Burden (Hours)	4,900	0	4,900
Cost Burden (Dollars)	0	0	0

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Abstract: NIOSH is charged with developing reasonable estimates of the radiation doses incurred occupationally by U.S. nuclear weapons workers with cancer that are covered by the Energy Employees Occupational Illness Compensation Program Act of 2000. These radiation dose reconstructions are completed using methods promulgated by HHS under 42 CFR 82. An essential data source for completing the dose reconstructions is the information collected through structured telephone interviews conducted with claimants, who may be energy employees or surviving family members. In some cases, if necessary, co-workers of the employee are interviewed. These individuals may have unique knowledge of work conditions, radiation protection measures, and monitoring practices that are not available from other sources. At the completion of the dose reconstruction process, claimants review the estimated radiation dose, and signify that they have no more relevant information to offer by submitting a conclusion form (OCAS-1).

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Authorizing Statute(s): PL: Pub.L. 106 - 398 3624 Name of Law: Enerby Employees Occupational Illness Compensation Program Act
   US Code: 42 USC 7384 Name of Law: EEOICPA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0920-ZA00	Final or interim final rulemaking	67 FR 22314	05/02/2002

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 60496	09/29/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 2065	01/13/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
EEOICPA Dose Reconstruction Introductory Letters & Telephone Interview
EEOICPA Dose Reconstruction Interviews Conclusion Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	12,600	12,600	0	0	0	0
Annual Time Burden (Hours)	4,900	4,900	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,083,333

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/18/2012

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